Magnetic resonance imaging of active sacroiliitis: Do we really need gadolinium?

Christian E. Althoff, Eugen Feist, Elena Burova, Iris Eshed, Matthias Bollow, Bernd Hamm, Kay Geert A. Hermann

Research output: Contribution to journalArticlepeer-review


Introduction: Magnetic resonance imaging (MRI) of active inflammatory changes of the sacroiliac joint (SIJ) in spondyloarthritis (SpA) is performed with short tau inversion recovery (STIR) sequences and fat-saturated T1-weighted fast spin-echo (FSE) sequences after administration of gadolinium-based contrast medium (T1/Gd). The aim of the present study was to compare these two pulse sequences in terms of diagnosis, diagnostic confidence, and quantification of inflammatory changes. Materials and methods: The study included 105 patients with suspected SpA; 72 patients developed clinical SpA over time. All patients were examined with STIR and T1/Gd and each of the two sequences was analyzed separately in conjunction with unenhanced T1 FSE images. For quantitative estimation of inflammatory changes, each sacroiliac joint (SIJ) was divided into 4 quadrants (and severity per quadrant was assigned a score of 0-4, resulting in a maximum sum score of 16 per SIJ). Diagnostic confidence was assessed on a visual analogue scale ranging from 0 to 10. Results: Active sacroiliitis was diagnosed in 46 patients and ruled out in 34 using STIR, whereas findings were inconclusive in 25 patients. The corresponding numbers for T1/Gd were 47, 44, and 14. Diagnostic confidence was significantly lower for STIR (7.3 ± 2.6) compared with T1/Gd (8.7 ± 1.9) (p < 0.001). The sum scores were 2.5 (±3.3) for STIR and 2.2 (±3.2) for T1/Gd for the right SIJ and 2.2 (±2.9) (STIR) and 1.9 (±3.1) (T1/Gd) for the left SIJ. Agreement was high with intraclass correlation coefficient (ICC) values of 0.86 for the right SIJ and 0.90 for the left SIJ and positive correlation (r = 0.62 right, 0.60 left). Summary: STIR sequences alone are sufficient for establishing a reliable diagnosis and quantify the amount of inflammation in active sacroiliitis. A contrast-enhanced study is dispensable in patients with established disease or in the setting of clinical follow-up studies. However, a contrast-enhanced MR sequence is beneficial to ensure maximum diagnostic confidence when patients with early sacroiliitis are examined.

Original languageEnglish
Pages (from-to)232-236
Number of pages5
JournalEuropean Journal of Radiology
Issue number2
StatePublished - Aug 2009
Externally publishedYes


  • Ankylosing spondylitis
  • Contrast medium
  • Sacroiliitis
  • Scoring
  • Spondyloarthritis


Dive into the research topics of 'Magnetic resonance imaging of active sacroiliitis: Do we really need gadolinium?'. Together they form a unique fingerprint.

Cite this